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Get and Sign United Healthcare Disclosure of Ownership Control Interest and Management Statement Form 2015-2022

Get and Sign United Healthcare Disclosure of Ownership Control Interest and Management Statement Form 2015-2022

Use a disclosure of ownership form 2015 template to make your document workflow more streamlined.

§455. Required information includes: 1) the identity of all owners and others with a controlling interest of 5% or greater; 2) certain business transactions as described in 42 CFR §455.105; 3) the identity of managers and others in a position of influence or authority; and 4) criminal conviction information for the provider, owners and managers. The information required includes, but it is not limited to, name, address, date of birth, social security number (SSN) and tax identification...
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